Morbilidad y mortalidad de la duodenopancreatectomía cefálica convencional en pacientes con enfermedad del confluente biliopancreático

Introducción: La duodenopancreatectomía cefálica es una operación cada vez más frecuente en pacientes seleccionados. Objetivo: Identificar la morbilidad y la mortalidad concerniente a la duodenopancreatectomía cefálica convencional. Métodos: Se realizó un estudio observacional, descriptivo de una serie de 15 casos operados de duodenopancreatectomía cefálica. Se investigaron las variables: estadificación según clasificación tumor, linfonódulo, metástasis (TNM), diagnóstico anatomopatológico, complicaciones, tiempo quirúrgico y estado al egreso. Se utilizaron el número absoluto y el porcentaje como medidas de resumen para las variables estadificación y diagnóstico; la media, la mediana y el rango para el tiempo quirúrgico y el intervalo de confianza para el estado al egreso. Resultados: El diagnóstico anatomopatológico principal fue adenocarcinoma de páncreas con 9 pacientes (60,1 %) y de duodeno con 2 (13,3 %). El estadio posoperatorio IIA fue el que prevaleció con 5 (45,5 %). El retraso del vaciamiento gástrico fue la complicación quirúrgica que prevaleció, con 7 (46,7 %) enfermos, seguida de la fístula biliar con 3 (20,0 %). La fístula pancreática, la lesión de la vena mesentérica superior y la hemorragia posoperatoria se presentaron una sola vez (6,7 %), respectivamente. Estas 2 últimas, provocaron la muerte del enfermo en las primeras 48 horas del posoperatorio. Fallecieron 4 (26,7 %) pacientes de la serie. Conclusiones: Las complicaciones posquirúrgicas se observan principalmente a expensas del retardo del vaciamiento gástrico, la fístula biliar y pancreática. La mortalidad puede estar relacionada con la prolongación del tiempo quirúrgico igual o mayor de 5 horas, con el consiguiente aumento de las pérdidas hemáticas.

Introduction: Cephalic duodenopancreatectomy is an increasingly frequent operation in selected patients. Objective: To identify the morbidity and mortality related to conventional cephalic duodenopancreatectomy. Methods: An observational, descriptive study of a series of 15 cases operated on cephalic duodenopancreatectomy. The variables were investigated: staging according to the Tumor, Linphonod, Metastasis (TNM) classification, pathological diagnosis, complications, surgical time and discharge status. Absolute number and percentage were used as summary measures for the variables staging and diagnosis; mean, median and range for surgical time and confidence interval for discharge status. Results: The main pathological diagnosis was adenocarcinoma of the pancreas with 9 patients (60.1%) and of the duodenum with 2 (13.3%). Postoperative stage IIA was the one that prevailed with 5 (45.5%) patients. Delayed gastric emptying was the prevailing surgical complication, with 7 (46.7%) patients, followed by biliary fistula with 3 (20.0%). Pancreatic fistula, superior mesenteric vein injury, and postoperative hemorrhage occurred only once (6.7%), respectively. These last 2, caused the death of the patient in the first 48 hours of the postoperative period. Four (26.7%) patients in the series died. Conclusions: Postoperative complications are mainly observed at the expense of delayed gastric emptying and biliary and pancreatic fistula. Mortality may be related to the prolongation of surgical time equal to or greater than 5 hours with the consequent increase of blood loss.

Características y resultados del tratamiento aplicado a los pacientes con cáncer de páncreas / Rejuvenation Surgery with High-Superficial Musculoaponeurotic System Flap

Introducción: El cáncer de páncreas mantiene un pronóstico ominoso a pesar de los avances en técnicas quirúrgicas y cuidados perioperatorios. Objetivo: Caracterizar los resultados del tratamiento aplicado a los pacientes con cáncer de páncreas. Métodos: Se realizó un estudio observacional, descriptivo y transversal de una serie de 70 pacientes con diagnóstico de cáncer de páncreas. Se estudiaron las variables: localización, tamaño del tumor, procedimiento quirúrgico, estadificación preoperatoria, diagnóstico histológico, estancia hospitalaria, complicaciones posoperatorias y estado al egreso, mediante el análisis de frecuencias absolutas, relativas y la media así como la prueba de ji al cuadrado y el IC 95 por ciento. Resultados: El procedimiento quirúrgico más frecuente fue derivativo en 47 enfermos (67,1 por ciento). La operación de Whipple se realizó en 10 pacientes (14,3 por ciento) con tumores localizados en la cabeza del páncreas y la pancreatectomía corporocaudal en 11 (15,7 por ciento) con tumores de cuerpo y cola del páncreas. La mayoría correspondió a los estadios III y IV. El 47,1 por ciento de los pacientes presentó un adenocarcinoma poco diferenciado. La estadía fluctuó entre 15 y 30 días en el 54,3 por ciento de la serie. Las complicaciones se presentaron en 19 enfermos (27,1 por ciento). Fallecieron 15 pacientes (21,4 por ciento) del total. Conclusiones: El tratamiento debe ser individualizado mediante equipos multidisciplinarios, con protocolos de actuación uniformes en cada institución que permita realizar estudios multicéntricos, con el objetivo de obtener estadísticas propias en aras de disminuir la morbilidad y la mortalidad, así como aumentar la calidad de vida de estos pacientes(AU)

Introduction: Facial rhytidectomy is the technique for correcting facial aging features, but they are becoming increasingly complex due to the incorporation of deeper planes in the process. The superficial musculoaponeurotic system techniques have the advantage of providing a greater degree of naturalness and permanence in time. Objective: To evaluate the effectiveness of the high-superficial musculoaponeurotic system technique for facial rejuvenation. Methods: A prospective and longitudinal case series study was carried out in the plastic surgery service of Hospital General Universitario "Vladimir Ilich Lenin" with patients who requested facial rejuvenation and were treated with the high-superficial musculoaponeurotic system technique, from January 1, 2018 to June 30, 2020. The variables age, sex, skin type, degree of aging, operative complications, patient satisfaction and aesthetic outcomes were studied. Results: The female sex predominated, together with the age group 50-59 years, the degrees of aging II and III, as well as white and light brown skin colors, while the most frequent operative complication was wound dehiscence of the suture line at the auricle root. The patients' satisfaction with the aesthetic outcomes of the surgical intervention was verified and the aesthetic outcomes was assessed as favorable in 100 percent of the cases for the used surgical technique. Conclusions: The high-superficial musculoaponeurotic system surgical technique for rhytidectomy offers harmonic, long-lasting outcomes with a low percentage of complications, making it a valuable alternative for patients(AU)

Caracterización clinicoepidemiológica de pacientes operados de duodenopancreatectomía cefálica con enfermedad del confluente biliopancreático / Clinical epidemiological characterization of patients operated on cephalic pancreaticoduodenectomy with disease of the biliopancreatic confluent

Introducción: La duodenopancreatectomía cefálica continúa siendo una intervención quirúrgica compleja. Objetivo: Caracterizar a los pacientes operados de duodenopancreatectomía cefálica según variables epidemiológicas, clínicas e histológicas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo y retrospectivo de una serie de 15 casos operados de duodenopancreatectomía cefálica en el Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, durante el quinquenio 2016-2020. Las variables analizadas fueron edad, sexo, comorbilidades, hábitos tóxicos, síntomas y signos, así como tipo histológico de las lesiones. Resultados: Predominaron los pacientes del sexo masculino (80,0 %) y el grupo de 50 a 55 años de edad (40,0 %). Las comorbilidades más frecuentes fueron la hipertensión arterial en 80,0 % de la casuística, seguida de la diabetes mellitus en 53,3 %. Prevalecieron el tabaquismo (66,7 %) y el alcoholismo (60,0 %), así como los signos de obstrucción biliar (73,3 %). El diagnóstico histológico principal fue adenocarcinoma de páncreas en 60,1 % de los afectados. Conclusiones: La duodenopancreatectomía cefálica se realiza predominantemente en pacientes con adenocarcinomas de páncreas y, en menor medida, con adenocarcinomas de duodeno y otras afecciones benignas; en afectados del sexo masculino, con edades intermedias y avanzadas de la vida, hipertensión arterial y diabetes mellitus, así como tiempo prolongado de ser fumadores y consumidores de alcohol. Los signos de obstrucción biliar son de importancia capital en el diagnóstico clínico.

Introduction: The cephalic pancreaticoduodenectomy continues being a complex surgical intervention. Objective: To characterize patients operated on cephalic duodenopancreatectomy according to selected epidemiological, clinical and histologic variables. Methods: An observational, descriptive and retrospective study of a series of 15 cases operated on cephalic pancreaticoduodenectomy was carried out in the General Surgery Service of Saturnino Lora Teaching Provincial Hospital in Santiago de Cuba, during the five year period 2016-2020. The analyzed variables were age, sex, comorbidities, toxic habits, symptoms and signs, as well as histologic type of the lesions. Results: There was a prevalence of the male sex patients (80.0 %) and the 50 to 55 age group (40.0 %). The most frequent comorbidities were hypertension in 80.0 % of the case material, followed by the diabetes mellitus in 53.3 %. Nicotine addiction (66.7 %) and alcoholism (60.0 %) prevailed, as well as the signs of biliary obstruction (73.3 %). The main histologic diagnosis was pancreas adenocarcinoma in 60.1 % of those affected. Conclusions: The cephalic pancreaticoduodenectomy is carried out predominantly in patients with pancreas adenocarcinomas and, to a lesser extent, in patients with duodenum adenocarcinomas and other benign affections; in those affected of the male sex, with intermediate and advanced ages of life, hypertension and diabetes mellitus, as well as long time of being smokers and alcohol consumers. The signs of biliary obstruction are of capital importance in the clinical diagnosis.

Caracterización clinicoepidemiológica de pacientes con cáncer de páncreas en un servicio de cirugía general / Clinical epidemiological characterization of patients with pancreas cancer in a general surgery service

Introducción: El cáncer de páncreas constituye una de las neoplasias de peor pronóstico debido a su diagnóstico tardío. Objetivo: Caracterizar a los pacientes con cáncer de páncreas según variables clinicoepidemiológicas y exámenes complementarios. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 70 pacientes con cáncer de páncreas, egresados del Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba durante el periodo 2016-2020. Se estudiaron las variables: edad, sexo, factores de riesgo, enfermedades asociadas, manifestaciones clínicas y exámenes complementarios. Resultados: Predominaron el sexo masculino ( 54,2 %), las edades comprendidas de entre 51- 70 años, la ingestión de comidas grasas y los hábitos tabáquico y alcohólico como factores de riesgo; el alcoholismo crónico, la diabetes mellitus y la hipertensión arterial como enfermedades asociadas más comunes, así como el síndrome general, la ictericia y la coluria entre las manifestaciones clínicas más frecuentes. Por su parte, según los estudios imagenológicos, la mayoría de los afectados se diagnosticaron mediante tomografía computarizada y ecografía abdominal (94,3 y 70,0 %, respectivamente). Conclusiones: La tomografía computarizada multicorte es la técnica de imagen de elección recomendada por las guías de consenso internacional. Si bien el informe radiográfico es clave para la toma de decisiones posteriores, existen circunstancias del paciente que pueden afectarlas, tales como edad, factores de riesgo, manifestaciones clínicas y comorbilidad, entre otras.

Introduction: The pancreas cancer constitutes one of the neoplasms with worse prognosis due to its late diagnosis. Objective: To characterize patients with pancreas cancer according to clinical epidemiological variables and complementary exams. Methods: An observational, descriptive and cross-sectional study of 70 patients with pancreas cancer was carried out, who were discharged from the General Surgery Service of Saturnino Lora Teaching Provincial Hospital in Santiago de Cuba during 2016-2020. The variables studied were: age, sex, risk factors, associated diseases, signs and symptoms and complementary exams. Results: There was a prevalence of the male sex (54.2 %), the 51-70 age group, the ingestion of fatty foods and nicotine addiction and alcoholism as risk factors, the chronic alcoholism, diabetes mellitus and hypertension as more common associated diseases, as well as the general syndrome, jaundice and coluria among the most frequent signs and symptoms. On the other hand, according to the imaging studies, most of those affected were diagnosed by means of computerized axial tomography and abdominal echography (94.3 and 70.0 %, respectively). Conclusions: The multiscan computerized axial tomography is the image technique of election recommended by the guides of international consent. The radiographic report is the key for later decisions making but there are circumstances of the patient that can affect them, such as age, risk factors, signs and symptoms and comorbidity, among others.

Dietary supplementation with nerolidol improves the antioxidant capacity and muscle fatty acid profile of Brycon amazonicus exposed to acute heat stress.

An increase in water temperature in the Amazon River has elicited concerns about commercially important fish species associated with food security, such as matrinxã (Brycon amazonicus). Studies have demonstrated the positive effects of diets supplemented with plant-based products that combat heat stress-induced oxidative damage. The aim of this study was to determine whether dietary supplementation with nerolidol prevents or reduces muscle oxidative damage and impairment of the fillet fatty acid profile of matrinxã exposed to heat stress. Plasma and muscle reactive oxygen species (ROS) and lipid peroxidation (LPO) levels were significantly higher in fish exposed to heat stress compared to fish not exposed to heat stress, while plasma superoxide dismutase (SOD) and glutathione peroxidase (GPx) activity was significantly lower. The total content of saturated fatty acids (SFA) in fillets was significantly higher in fish exposed to heat stress compared to fish not exposed to heat stress, while he total content of polyunsaturated fatty acids (PUFA) was significantly lower. Nerolidol prevented the increase of muscle LPO and plasma ROS and LPO levels in fish exposed to heat stress, and partially prevented the increase in muscle ROS levels. Diets containing nerolidol prevented the inhibition of muscle GPx activity in fish exposed to heat stress, and partially prevented the decrease of plasma GPx activity. The nerolidol-supplemented diet prevented the increase of fillet SFA in fish exposed to heat stress, while partially preventing the decrease of PUFA. We conclude that acute heat stress at 34 °C for 72 h causes plasma and muscular oxidative damage, and that homeoviscous adaptation to maintain membrane fluidity can represent a negative impact for fish consumers. A nerolidol diet can be considered a strategy to prevent heat stress-induced oxidative damage and impairment of muscle fatty acid profiles.

Involvement of purinergic system and electron transport chain in two species of cichlids from the Amazon basin exposed to hypoxia.

The Amazonian aquatic ecosystem undergoes seasonal variations and daily changes that directly affect the availability of oxygen. During the day the levels of oxygen can reach supersaturation, and at night can drop to zero. In this way, aquatic organisms are exposed daily to physiological challenges regarding the availability of oxygen. The present study revealed significant differences in the physiology and performance of two cichlids: Geophagus proximus (black water cichlid - from Negro River) and Chaetobranchopsis orbicularis (white water cichlid - from Amazon River), exposed to hypoxia. The white water cichlid showed lower value (1.99 ± 0.79 pKa) of critical pressure of oxygen (Pcrit) and a longer time (68.00 ± 14.11 min) for total loss of balance (LOE); however, this species showed 50% mortality during exposure to hypoxia, while the black water cichlid did not show mortality. Both cichlids presented a decrease in O2 consumption rate (OCR) during hypoxia.. In this sense, it was observed that the black water cichlid presented several physiological strategies during hypoxia, such as, a significant increase in plasma cortisol levels, nucleoside triphosphate diphosphohydrolase activity (for adenosine diphosphate (ADP) as a substrate) in the gills, and the activity of adenosine deaminase (ADA) in gills and liver, in addition to a significant increase in the activity of complexes (II-III) in the transporter chain of electrons in both analyzed tissues and succinate dehydrogenase activity of gills' mitochondria. On the other hand, the only physiological change observed in the white water cichlid was a significant reduction in the activity of complexes II-III in gills and liver. Based on our findings, we can hypothesize that the white water cichlid specie has less tolerant to hypoxia when compared to the black water cichlid.

Consequences of oxidative damage on the fatty acid profile in muscle of Cichlasoma amazonarum acutely exposed to copper.

Rapid industrialization results in the production of large quantities of waste that are commonly discharged into water bodies, leading to the damage of the aquatic ecosystem and freshwater organisms. Copper (Cu) can induce oxidative damage in fish muscle, the main fish portion that is consumed by humans. However, the responses of the Amazon fish Cichlasoma amazonarum and its capacity to withstand acute Cu concentrations found in Amazon water around mines remain unknown. Thus, the aim of this study was to evaluate whether exposure to Cu causes muscle oxidative stress and/or oxidative damage and impairs the fillet fatty acid profile of C. amazonarum acutely exposed to Cu found in Amazon waters around mines. Muscle reactive oxygen species and protein carbonylation levels were significantly higher in fish exposed to 1500 µg/L Cu compared with the control group, while muscle lipid peroxidation levels were significantly higher in fish exposed to 500, 750, and 1500 µg/L Cu compared with control group. Muscle antioxidant capacity against peroxyl radical's levels and glutathione peroxidase activity were significantly lower in fish exposed to 1500 µg/L Cu compared with the control group, while muscle superoxide dismutase activity was significantly lower in fish exposed to 750 and 1500 µg/L Cu compared with control group. The total content of saturated fatty acids was significantly higher in fish exposed to 1500 µg/L Cu compared with the control group, while the total content of monounsaturated fatty acids and sum of n3 fatty acids were significantly lower in fish exposed to 1500 µg/L Cu compared with control group. No significant difference was observed regarding muscle catalase, glutathione S-transferase, and glutathione reductase activities. Based on these lines of evidence, the results of this comprehensive study agree with the initial hypothesis that the exposure to Cu found in Amazon water around mines induces oxidative damage and inhibits enzymatic and non-enzymatic antioxidant response in the muscle of C. amazonarum exposed to high Cu levels. Moreover, the impairment of the fillet fatty acid profile appears to be mediated by oxidative damage, representing a negative impact on fish health.

Acute exposure to environmentally relevant concentrations of copper affects branchial and hepatic phosphoryl transfer network of Cichlasoma amazonarum: Impacts on bioenergetics homeostasis.

The toxic effects of copper (Cu) are linked to dysfunction of metabolism and depletion of adenosine triphosphate (ATP). Nevertheless, the effects related to phosphoryl transfer network, a network of enzymes to precise coupling of the ATP-production and ATP-consuming process for maintenance of bioenergetic, remain unknown. Therefore, the aim of this study was to determine whether the phosphoryl transfer network could be one pathway involved in the bioenergetic imbalance of Cichlasoma amazonarum exposed for 96 h to environmentally relevant concentrations of Cu found in Amazonia water around mines. Branchial mitochondrial creatine kinase (CK) activity was significantly lower in fish exposed to 1500 µg/L Cu than in the control group, while branchial cytosolic CK activity was significantly greater. Branchial (exposed to 750 and 1500 µg/L Cu) and hepatic (exposed to 1500 µg/L Cu) pyruvate kinase (PK) activity was significantly lower in fish exposed to Cu than in the control group. Branchial and hepatic ATP levels were significantly lower in fish exposed to 1500 µg/L than in the control group. Branchial reactive oxygen species (ROS) and lipid peroxidation (LPO) levels were significantly higher in fish exposed to 750 and 1500 µg/L Cu compared to control. Hepatic ROS and LPO levels were significantly higher in fish exposed to 1500 µg/L than in the control group. Branchial and hepatic Cu levels were significantly higher in fish exposed to 1500 µg/L compared to other groups. Exposure to 750 and 1500 µg/L Cu impairs bioenergetics homeostasis, which appears to be mediated by ROS overproduction and lipid peroxidation.

Dietary exposure to ochratoxin A reduces growth performance and impairs hepatic purinergic signaling in tambaqui (Colossoma macropomum).

The practice of replacing costly animal-derived proteins with more economical plant proteins has augmented the risk of mycotoxin contamination in fish feeds, including contamination with ochratoxin A (OTA). OTA is a secondary metabolite produced by molds commonly found in fish feeds that causes impairment of performance in several fish species and some hepatic biochemical alterations. However, the pathways involved in hepatic damage remain unknown and are limited to histopathological alterations. Purinergic signaling is a homeostatic system that continuously monitors the internal environment to detect injury primarily by two intercellular messengers: adenosine triphosphate (ATP) and adenosine (Ado). The objective of this study was to determine whether OTA-contaminated feed induces the release of nucleotides in the extracellular milieu, as well as whether ectoenzymes modulate ATP pro-inflammatory effects in liver of tambaqui (Colossoma macropomum). Final mean weight, weight gain (WG), and liver weight were significantly lower in tambaqui fed feeds containing 1.6 and 2.4 mg OTA/kg feed than in the control group. Liver ATP and Ado levels were significantly higher in tambaqui fed feeds containing 1.6 and 2.4 mg OTA/kg feed compared with control, while no significant difference was observed regarding adenosine diphosphate and adenosine monophosphate levels. Hepatic triphosphate diphosphohydrolase (NTPDase) activity (for ATP) was significantly greater in tambaqui fed feeds containing 1.6 and 2.4 mg OTA/kg feed compared with control, while adenosine deaminase (ADA) activity was lower. No significant difference was observed with respect to hepatic NTPDase activity (for ADP) or for 5'-nucleotidase activity. Finally, levels of liver metabolites of nitric oxide were significantly higher in tambaqui fed feeds containing 1.6 and 2.4 mg OTA/kg feed than in the control group. Based on these data, exposure to 1.6 and 2.4 mg OTA/kg feed impaired tambaqui growth performance associated with final mean weight and WG. Levels of two important intercellular messengers, ATP and Ado, increased in the extracellular space as a consequence of hepatic damage, exerting opposite immune responses. Finally, liver NTPDase and ADA activities were altered to modulate ATP and Ado levels, respectively, exerting anti-inflammatory effects to counteract OTA-induced hepatic injury.

Disturbance of oxidant/antioxidant status and impairment on fillet fatty acid profiles in Brycon amazonicus subjected to acute heat stress.

Amazon fish are vulnerable to climate change. Current temperature increases in Amazonian rivers are likely to continue in the coming years. Elevated temperatures impair homeostasis and subject fish to oxidative stress; nevertheless, the effects of elevated temperature on plasma and muscle oxidative stress as well as fillet fatty acid composition in matrinxã (Brycon amazonicus) remain unknown. Therefore, the aims of the present study were to determine whether antioxidant system is able to withstand acute thermal stress to avoid plasma and muscle oxidative damage and to determine the manner in which matrinxã adjust their muscle fatty acid metabolism in a response to acute heat stress. We exposed juvenile matrinxã to four temperatures (28 °C as control and 30, 32, and 34 °C) for 72 h and observed the effects on plasma and muscle oxidant/antioxidant status and on fatty acid composition. Plasma reactive oxygen species (ROS) and lipid peroxidation (LPO) levels were significantly higher in matrinxã exposed to 34 °C compared with the control group, while they were significantly higher in the muscle of matrinxã exposed to 32 °C and 34 °C compared with the control group. Superoxide dismutase (SOD) activity and total antioxidant capacity (TAC) levels were significantly lower in the plasma and muscle of matrinxã exposed to 34 °C compared with the control group. Plasma glutathione peroxidase (GPx) activity was significantly lower in matrinxã exposed to 32 and 34 °C compared with the control group, while it was significantly lower in the muscle of matrinxã exposed to 34 °C. The total content of saturated fatty acid (SFA) was significantly higher in the fillet of matrinxã exposed to 34 °C compared with the control group, while the total content of polyunsaturated fatty acid (PUFA) was significantly lower. Based on this evidence, we conclude that acute heat stress at 32 °C and 34 °C causes plasma and muscular oxidative stress, and the enzymatic and non-enzymatic antioxidant system is unable to prevent oxidative damage. Moreover, increased levels of total SFA and decreased levels of PUFA occur in an attempt to withstand heat stress and maintain membrane fluidity; nevertheless, these responses can represent negative impacts for consumers.

Purine levels and purinergic signaling in plasma and spleen of Brycon amazonicus exposed to acute heat thermal stress: An attempt to regulate the immune response.

Amazon fish are vulnerable to climate change. Several lines of evidence suggest that the temperature of Amazonian rivers will increase in the coming years. Elevated temperature disturbs homeostasis and subjects fish to physiological stress; however, the effects of temperature on immunity remain poorly understood, particularly those effects involving purinergic signaling. This system fine-tunes the inflammatory and immune responses triggered by stress. Therefore, the aims of this study were to determine whether acute heat stress induces the release of nucleotides into extracellular compartment and to determine whether purinergic enzymes modulate the proinflammatory effects of adenosine triphosphate (ATP) in plasma and spleen of matrinxã (Brycon amazonicus) exposed to acute heat stress. We exposed juvenile matrinxã to four temperature regimes (28 °C as control, 30, 32 and 34 °C) for 72 h and observed the effects on purinergic signaling. Plasma cortisol levels were significantly higher in fish exposed to 34 °C than in the control group, while spleen ATP, adenosine diphosphate (ADP) and adenosine monophosphate (AMP) levels were significantly higher in this group than in controls. Activities of spleen nucleoside triphosphate diphosphohydrolase (NTPDase) and 5'-nucleotidase were significantly higher in fish exposed to 34 °C than those of the control group, while spleen interleukin-1 (IL-1) and interleukin-6 (IL-6) levels were higher in this same group than in the control group. No significant differences were observed between the groups regarding plasma parameters. Based on these data, we concluded that acute heat stress at 34 °C caused physiological stress in matrinxã, manifesting as elevated plasma cortisol levels. The most important finding is that purinergic enzymes were modulated, though not efficiently, in response to the excessive release of nucleotides into the extracellular space. In summary, the purinergic signaling pathway may be involved in the impairment of immune and inflammatory responses in matrinxã exposed acutely to 34 °C.

Dietary ochratoxin A (OTA) decreases growth performance and impairs muscle antioxidant system and meat fatty acid profiles in juvenile tambaqui (Colossoma macropomum).

Plant-based ingredients are successfully replacing fishmeal in fish feeds. However, this practice increases the risk of feed contamination by mycotoxins that reduce production and heath associated with oxidative damage. The aim of this study was to determine whether feed contaminated with environmentally relevant concentrations of ochratoxin A (OTA) causes muscle oxidative damage in tambaqui (Colossoma macropomum), and to determine whether this feed impairs fatty acid profiles in fish meat. Final mean weight, weight gain, daily weight gain, feed efficiency, and specific growth rate were significantly lower in fish fed 1.6 and 2.4 mg OTA/kg compared to those fed basal diet, while feed conversion was significantly higher in these same groups compared to the basal group. Levels of reactive oxygen species and lipid peroxidation in muscle were significantly higher in fish fed 1.6 and 2.4 mg OTA/kg compared to those in the basal group. Likewise, muscle superoxide dismutase and glutathione peroxidase activities were significantly higher in fish fed 1.6 and 2.4 mg OTA/kg then in those fed basal feed. The total content of saturated fatty acids was significantly higher, and total content of polyunsaturated fatty acids was significantly lower in fish fed 2.4 mg OTA/kg compared to those fed basal feed. Taken together, the data suggest that OTA-contaminated feed induces oxidative damage and disturbs enzymatic and non-enzymatic antioxidant responses in tambaqui meat. The perturbations of fatty acid profiles in fish meat appears to mediated by oxidative damage, representing negative impact on fish health and presenting concerns for consumers of fish.

Temperature and food availability alters the physiology and aerobic capacity of tambaqui (Colossoma macropomum).

Fish of the Amazon experience both daily and seasonal variation in temperature and food availability. In the present work, we investigated the influence of nutrient status changes resulting from feeding Colossoma macropomum five flooded forest fruits on aerobic and swimming performance. To assess the effects of diet, three groups of fish were provided different types of food. One group of was provided with commercial feed, another was given fruit feed, and the last group was not fed. The effects of temperature were tested by keeping half of each group of animals at either 26 °C or 33°C for 30 days. After this period, the animals were transferred to either a respiratory chamber or swimming tunnel. Then, tissues were collected for relevant analyses. Results showed that C. macropomum depresses aerobic metabolism when food is withheld (27% reduction in MO2), and observed effects were intensified at the highest temperature (40% reduction in MO2 at 33 °C). Further, increased temperature negatively influenced hematological (Ht, Hb, VCM), biochemical (glucose, triglycerides, cholesterol), hepatossomatic index and enzymatic (MDH and CS in white muscle) parameters. The animals feeding commercial and fruits enriched diets, have a physiological and biological advantage when compared to the unfed animals at both temperatures. Metabolic suppression is an important strategy for maintaining swimming capacity in C. macropomum. It is suggested that even after a long period of fasting, carbohydrates are important energetic substrates.

Conocimientos vigentes en torno a las lesiones iatrogénicas de vías biliares / Updated knowledge about iatrogenic injuries of the biliary ducts

Con la llamada era laparoscópica, lejos de disminuir la incidencia de las lesiones iatrogénicas de las vías biliares, se ha producido un aumento de ésta y se han añadido otras que no se presentaban en la cirugía convencional y por lo general son más graves y complejas por su localización más proximal, su frecuente asociación con lesión vascular y por el mecanismo térmico involucrado. Estas lesiones trascienden el orden científico, para constituir un problema socioeconómico, pues además de lacerar el prestigio de los cirujanos y de las instituciones médicas donde laboran, y de encarecer los servicios de salud que se brindan a la población, pueden determinar incapacidad laboral en los enfermos y ocasionar la pérdida de vidas humanas en edades productivas. Se evidencian insuficiencias en la identificación y reparación oportunas de dichas lesiones, así como escasos reportes en la bibliografía médica sobre este tema. Con esta revisión se pretende profundizar en los diversos aspectos cognoscitivos actuales relacionados con esta lamentable complicación quirúrgica y fundamentalmente para su prevención(AU)

With the so called laparoscopic age, far from a decrease in the incidence of iatrogenic injuries of the biliary ducts, an increase has taken place, and others have been added that are not commonly present in conventional surgery and which are generally more serious and complex for their more proximal localization, their frequent association with vascular injury, and for the involved thermal mechanism. These injuries go beyond the scientific scope, and become a socioeconomic problem, since they not only damage the surgeon prestige and that of medical institutions where they work, or make healthcare services provided to the population more difficult based on the expenses, but also determine disability in ill patients and produce the loss of humans lives at productive ages. Inadequacies are shown in the identification and opportune repair of these injuries, as well as few reports in the medical literature about this topic. With this review, it is sought to deepen in the diverse updated cognitive aspects related to this regrettable surgical complication, and mainly for its prevention(AU)

Conocimientos vigentes en torno a las lesiones iatrogénicas de vías biliares / Updated knowledge about iatrogenic injuries of the biliary ducts

Con la llamada era laparoscópica, lejos de disminuir la incidencia de las lesiones iatrogénicas de las vías biliares, se ha producido un aumento de ésta y se han añadido otras que no se presentaban en la cirugía convencional y por lo general son más graves y complejas por su localización más proximal, su frecuente asociación con lesión vascular y por el mecanismo térmico involucrado. Estas lesiones trascienden el orden científico, para constituir un problema socioeconómico, pues además de lacerar el prestigio de los cirujanos y de las instituciones médicas donde laboran, y de encarecer los servicios de salud que se brindan a la población, pueden determinar incapacidad laboral en los enfermos y ocasionar la pérdida de vidas humanas en edades productivas. Se evidencian insuficiencias en la identificación y reparación oportunas de dichas lesiones, así como escasos reportes en la bibliografía médica sobre este tema. Con esta revisión se pretende profundizar en los diversos aspectos cognoscitivos actuales relacionados con esta lamentable complicación quirúrgica y fundamentalmente para su prevención(AU)

With the so called laparoscopic age, far from a decrease in the incidence of iatrogenic injuries of the biliary ducts, an increase has taken place, and others have been added that are not commonly present in conventional surgery and which are generally more serious and complex for their more proximal localization, their frequent association with vascular injury, and for the involved thermal mechanism. These injuries go beyond the scientific scope, and become a socioeconomic problem, since they not only damage the surgeon prestige and that of medical institutions where they work, or make healthcare services provided to the population more difficult based on the expenses, but also determine disability in ill patients and produce the loss of humans lives at productive ages. Inadequacies are shown in the identification and opportune repair of these injuries, as well as few reports in the medical literature about this topic. With this review, it is sought to deepen in the diverse updated cognitive aspects related to this regrettable surgical complication, and mainly for its prevention(AU)

Caracterización de pacientes con lesiones quirúrgicas iatrogénicas de las vías biliares / Characterization of patients with surgical iatrogenic injuries of the biliary apparatus

Se realizó un estudio descriptivo de 35 pacientes intervenidos quirúrgicamente mediante las técnicas convencional y laparoscópica, quienes presentaron lesiones iatrogénicas de las vías biliares, en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, en un período de 8 años (2007-2014), con vistas a caracterizarles según algunas variables de interés y determinar la mortalidad asociada. Entre los resultados preponderantes figuraron el sexo femenino y las edades de 35 a 54 años, las lesiones producidas de la colecistectomía videolaparoscópica electiva por litiasis vesicular, las formas clínicas de presentación el absceso intraabdominal con signos de peritonitis e ictericia, cuyo diagnóstico fue confirmado mediante la ecografía. Asimismo, las lesiones de tipo A y C, según la clasificación de Strasberg, fueron las más reiteradas y el procedimiento técnico reparador más común fue el drenaje y lavado de la cavidad abdominal; 88,6 % de los pacientes egresaron vivos y 4 féminas fallecieron (11,4 por ciento), cuya causa de muerte fue el choque séptico. Pudo concluirse que el momento del diagnóstico de estas lesiones se efectuaba tardíamente, y que a pesar de la complejidad de la reparación quirúrgica, existió baja mortalidad(AU)

A descriptive study of 35 surgically treated patients by means of conventional and laparoscopic techniques who presented iatrogenic injuries of the biliary system, was carried out in the General Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, in a 8 year period (2007-2014), with the aim of characterizing them according to some variables of interest and of determining the associated mortality. Among the predominant results there were the female sex and the ages from 35 to 54 years, the produced lesions of the elective videolaparoscopic cholecystectomy for vesicular lithiasis, the clinical forms of presentation the intraabdominal abscess with peritonitis signs and jaundice, diagnosis confirmed by means of the echography. Also, injuries A and C, according to the classification of Strasberg, were those most reiterated and the most common restorative technical procedure was drainage and washing of the abdominal cavity; 88.6% of the patients were discharged alive and 4 female patients died (11.4 percent) whose cause of death was the septic shock. It could be concluded that the moment of diagnosis for these lesions took place late, and that in spite of the complexity of the surgical repair, there was low mortality.

Caracterización de pacientes con lesiones quirúrgicas iatrogénicas de las vías biliares / Characterization of patients with surgical iatrogenic injuries of the biliary apparatus

Se realizó un estudio descriptivo de 35 pacientes intervenidos quirúrgicamente mediante las técnicas convencional y laparoscópica, quienes presentaron lesiones iatrogénicas de las vías biliares, en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, en un período de 8 años (2007-2014), con vistas a caracterizarles según algunas variables de interés y determinar la mortalidad asociada. Entre los resultados preponderantes figuraron el sexo femenino y las edades de 35 a 54 años, las lesiones producidas de la colecistectomía videolaparoscópica electiva por litiasis vesicular, las formas clínicas de presentación el absceso intraabdominal con signos de peritonitis e ictericia, cuyo diagnóstico fue confirmado mediante la ecografía. Asimismo, las lesiones de tipo A y C, según la clasificación de Strasberg, fueron las más reiteradas y el procedimiento técnico reparador más común fue el drenaje y lavado de la cavidad abdominal; 88,6 % de los pacientes egresaron vivos y 4 féminas fallecieron (11,4 %), cuya causa de muerte fue el choque séptico. Pudo concluirse que el momento del diagnóstico de estas lesiones se efectuaba tardíamente, y que a pesar de la complejidad de la reparación quirúrgica, existió baja mortalidad.

A descriptive study of 35 surgically treated patients by means of conventional and laparoscopic techniques who presented iatrogenic injuries of the biliary system, was carried out in the General Surgery Service of "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, in a 8 year period (2007-2014), with the aim of characterizing them according to some variables of interest and of determining the associated mortality. Among the predominant results there were the female sex and the ages from 35 to 54 years, the produced lesions of the elective videolaparoscopic cholecystectomy for vesicular lithiasis, the clinical forms of presentation the intraabdominal abscess with peritonitis signs and jaundice, diagnosis confirmed by means of the echography. Also, injuries A and C, according to the classification of Strasberg, were those most reiterated and the most common restorative technical procedure was drainage and washing of the abdominal cavity; 88.6% of the patients were discharged alive and 4 female patients died (11.4%) whose cause of death was the septic shock. It could be concluded that the moment of diagnosis for these lesions took place late, and that in spite of the complexity of the surgical repair, there was low mortality.

Algunas especificidades en torno a las neoplasias primarias del segmento hepatobiliopancreático / Some specificities about primary neoplasms of the hepatobiliopancreatic segment

Hoy día existen muchos criterios sobre las características clinicoepidemiológicas y quirúrgicas de las neoplasias primarias del segmento hepatobiliopancreático, lo cual constituye un verdadero problema científico, por las tasas elevadas de letalidad y mortalidad, por cuanto resulta de gran importancia identificar los factores pronósticos de complicaciones y decesos, inherentes a esta entidad clínica, a fin de elaborar un protocolo de actuación y buenas prácticas. Todo ello justifica la necesidad de profundizar en los principales aspectos cognoscitivos relacionados con este tema, puesto que solo contando con equipos de trabajo altamente especializados, podrá elevarse la calidad asistencial y, por tanto, el índice de supervivencia de quienes presenten esa lamentable enfermedad(AU)

Nowadays there are many approaches about the surgical and clinical-epidemiological characteristics of the primary neoplasms in the hepatobiliopancreatic segment, that constitutes a true scientific problem, for its high rates of lethality and mortality, so it is very important to identify the prognosis factors of complications and deaths, inherent in this clinical entity, in order to elaborate a performance protocol and good practice. Everything is justified by the necessity to deepen in the main cognitive aspects related to this topic, since just counting on highly specialized work teams, the assistance quality will be higher, therefore, the survival rate of those who present that terrible disease(AU)

Algunas especificidades en torno a las neoplasias primarias del segmento hepatobiliopancreático / Some specificities about primary neoplasms of the hepatobiliopancreatic segment

Hoy día existen muchos criterios sobre las características clinicoepidemiológicas y quirúrgicas de las neoplasias primarias del segmento hepatobiliopancreático, lo cual constituye un verdadero problema científico, por las tasas elevadas de letalidad y mortalidad, por cuanto resulta de gran importancia identificar los factores pronósticos de complicaciones y decesos, inherentes a esta entidad clínica, a fin de elaborar un protocolo de actuación y buenas prácticas. Todo ello justifica la necesidad de profundizar en los principales aspectos cognoscitivos relacionados con este tema, puesto que solo contando con equipos de trabajo altamente especializados, podrá elevarse la calidad asistencial y, por tanto, el índice de supervivencia de quienes presenten esa lamentable enfermedad.

Nowadays there are many approaches about the surgical and clinical-epidemiological characteristics of the primary neoplasms in the hepatobiliopancreatic segment, that constitutes a true scientific problem, for its high rates of lethality and mortality, so it is very important to identify the prognosis factors of complications and deaths, inherent in this clinical entity, in order to elaborate a performance protocol and good practice. Everything is justified by the necessity to deepen in the main cognitive aspects related to this topic, since just counting on highly specialized work teams, the assistance quality will be higher, therefore, the survival rate of those who present that terrible disease.

Supervivencia de los pacientes con neoplasias primarias del segmento hepatobiliopancreático / Survival of patients with primary neoplasias of the hepatobiliopancreatic segment

Se realizó un estudio descriptivo de 60 pacientes operados y egresados con diagnóstico de cáncer primario del segmento hepatobiliopancreático, atendidos en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, en el período 2005-2011, expuestos a un esquema de seguimiento posoperatorio, con vistas a identificar los factores relacionados con la supervivencia a los 5 años. La supervivencia global fue de 17,6 %, aunque resultó mayor para las neoplasias de vesícula biliar y páncreas, asociado al diagnóstico en las etapas I y II, a la cirugía curativa y al tratamiento adyuvante con citostáticos. Se concluye que la baja supervivencia de estos pacientes está determinada por el diagnóstico tardío del proceso morboso, por lo que se impone una mejor interrelación entre los niveles primario y secundario de atención, así como establecer grupos de trabajo para el desarrollo de la cirugía del segmento hepatobiliopancreático en cada hospital, de manera que permitan la protocolización uniforme de la conducta a seguir.

A descriptive study of 60 operated and discharged patients with diagnosis of primary cancer of the hepatobiliopancreatic segment, assisted in the General Surgery Service of "Saturnino Lora Torres" Teaching Provincial Clinical Surgical Hospital in Santiago de Cuba was carried out in the period 2005-2011, exposed to an scheme of postoperative follow-up, with the objective of identifying the factors related to the survival for 5 years. The global survival was 17.6%, although it was higher for the gallbladder neoplasias and pancreas, associated with the diagnosis in the stages I and II, to the healing surgery and to the auxiliary treatment with cytostatic. It is concludes that the low survival of these patients is determined by the late diagnosis of the morbid process, so that a better interrelation is imperative between the primary and secondary levels of care, as well as to establish work groups for the development of surgery of the hepatobiliopancreatic segment in each hospital, so that they allow the uniform protocol of the behaviour to be followed.